Neonatal Intensive Unit Research Articles

Do you believe in dragons? An outbreak of Salmonella ser. Agbeni in the Neonatal Intensive Care Unit

Introduction Nontyphoidal Salmonella encompasses over 2500 serotypes of S. enterica subsp. enterica capable of causing asymptomatic infection, self-limited gastroenteritis, or invasive disease. Neonates are at high risk for invasive disease given the immaturity of their gastrointestinal tract and cell-mediated immunity. They also excrete bacteria longer after infection than older individuals. In nurseries, outbreaks may last months to years. Serotyping is essential for tracking outbreaks and can predict both severity of illness and source of infection. While traditional serotyping uses DNA fingerprinting, Salmonella surveillance is moving towards whole genome sequencing (WGS) for more precise characterization of isolates. Laptop-compatible sequencing technology and open-source bioinformatics make WGS accessible …

Diagnostic utility of procalcitonin as a biomarker for late-onset neonatal sepsis.

BackgroundTo explore the diagnostic utility of procalcitonin (PCT) as a biomarker for late-onset neonatal sepsis (LONS).MethodsThe clinical and laboratory data of 131 neonatal patients in the neonatal intensive cares unit (NICU) of our center (Department of Neonatology, Renmin Hospital of Wuhan University) from June 1, 2015, to May 31, 2018, were retrospectively analyzed. These patients were divided into 3 groups based on their disease conditions: the bacterial sepsis (BS) group (n=47), the fungal sepsis (FS) group (n=39), and the normal control group (n=45, without sepsis). Blood cultures, routine blood tests, and testing for PCT and C-reactive protein (CRP) were performed in all 3 groups. Both PCT and CRP were measured by using enzyme-linked immunosorbent assay (ELISA). Blood culture was performed in an automated blood culture system. Routine blood tests were performed by using a fully automatic hematology analyzer.ResultsSerum PCT level was significantly different between the BS group and control group (P<0.01) but showed no significant difference between the FS group and control group (P>0.05); the difference in CRP was statistically significant between the FS group and control group (P<0.01) but was not statistically significant between the BS group and control group (P>0.05). The areas under the receiver operating characteristics (ROC) curve were 0.979 and 0.826 for PCT/CRP in the BS group and FS group, with a best cutoff value of 0.93 and 33.27, respectively; the sensitivities and specificities of PCT/CRP in these 2 groups were 0.962/0.679 and 0.964/0.964, respectively.ConclusionsCompared with CRP, PCT is more sensitive in diagnosing BS but is not sensitive for diagnosing FS. Therefore, PCR is a useful biomarker in distinguishing BS from FS in neonates with late-onset sepsis.

Changes in serum human cartilage glycoprotein-39 and high-mobility group box 1 in preterm infants with bronchopulmonary dysplasia

To study the association of the dynamic changes of peripheral blood human cartilage glycoprotein-39 (YKL-40) and high-mobility group box 1 (HMGB1) with bronchopulmonary dysplasia (BPD) in preterm infants. Preterm infants, with a gestational age of 28-32 weeks and a birth weight of <1 500 g, who were admitted to the neonatal intensive care unit from July 2017 to August 2019 were prospectively selected and divided into a BPD group with 35 infants and a non-BPD group with 51 infants. ELISA was used to measure the serum concentrations of YKL-40 and HMGB1 in preterm infants on days 3, 7, and 14 after birth. The BPD group had a significantly lower serum YKL-40 concentration and a significantly higher serum HMGB1 concentration than the non-BPD group on days 3, 7, and 14 (P<0.001). The serum concentrations of YKL-40 and HMGB1 on days 7 and 14 were significantly higher than those on day 3 in both groups (P<0.017). In the BPD group, HMGB1 concentration on day 14 was significantly higher than that on day 7 (P<0.017), while there was no significant change in YKL-40 concentration from day 7 to day 14 (P>0.017). In the non-BPD group, YKL-40 concentration on day 14 was significantly higher than that on day 7 (P<0.017), while there was no significant change in HMGB1 concentration from day 7 to day 14 (P>0.017). There are significant differences in the levels of YKL-40 and HMGB1 in peripheral blood between the preterm infants with BPD and those without BPD on days 3, 7, and 14 after birth, suggesting that YKL-40 and HMGB1 might be associated with the development of BPD.

Comparative study on the incidence of retinopathy of prematurity in premature infants born in the hospital and transported from other hospitals

Objective To explore the incidence, diagnosis and treatment of retinopathy of prematurity(ROP) in preterm infants born in the Guangdong Women and Children′s Hospital and transported from other hospital. Method s Clinical data of 755 premature infants with ROP at Neonatal Intensive Care Unit, Guangdong Women and Children′s Hospital from January 2013 to December 2015 were retrospectively analyzed.There were 239 cases born in the hospital and 516 cases transported from other hospitals.Their gestational age, birth weight, gender, severity of ROP lesion and clinical data were collected and compared. Result s The birth weight in the group of transported from other hospital was lower than that in the group of born in the hospital[(1 290.64±392.87) g vs.(1 586.21±512.74) g], and the difference was statistically significant(P<0.001). The ROP diagnosis of gestational age in the group of transported from other hospital was higher than that in the group of born in the hospital[(35.53±2.81)weeks vs.(34.51±2.17)weeks], and the difference was statistically significant(P<0.001). On the proportion of severe condition [such as lesion area Ⅰ, aggressive posterior retinopathy of prematurity(AP-ROP) and plus combined lesions], in the group of transported from other hospital was higher than that in the group of born in the hospital, and the differences was statistically significant(P<0.001). In the comparison of the proportion of laser photocoagulation, vitreous injection, combination of the two operations and supplementary laser therapy, in the group of transported from other hospital were higher than those in the group of born in the hospital[60.1%(310/516 cases) vs.20.9%(50/239 cases); 10.9%(56/516 cases) vs.2.5%(6/239 cases); 8.1%(42/516 cases) vs.1.7%(4/239 cases); 4.5%(23/516 cases) vs.1.3%(3/239 cases)], and the differences were statistically significant(all P<0.001). Conclusions Premature infants with ROP transported from other hospitals have lower birth weight, severe ROP lesions and high surgical intervention rate.Improving ROP screening level in primary hospitals, timely diagnosis and efficient transportation can help to effectively prevent the deterioration of ROP in premature infants and improve their quality of life. Key words: Retinopathy of prematurity; Infant, preterm; Transport

Risk factors for minimally invasive surfactant administration failure in preterm infants with respiratory distress syndrome

To identify risk factors for minimally invasive surfactant administration (MISA) failure in the treatment of preterm infants with respiratory distress syndrome (RDS) and the influence of MISA failure on neonatal outcome. A retrospective analysis was performed for the clinical data of 148 preterm infants with a gestational age of ≤32 weeks and a clinical diagnosis of RDS, who were admitted to the neonatal intensive care unit of eight tertiary hospitals in Beijing, Tianjin and Hebei Province from July 1, 2017 to December 31, 2018 and were treated with MISA (bovine pulmonary surfactant, PS). According to whether MISA failure (defined as the need for mechanical ventilation within 72 hours after MISA) was observed, the infants were divided into two groups: MISA failure group (n=16) and MISA success (n=132). A logistic regression analysis was used to investigate the risk factors for MISA failure and its influence on neonatal outcome. The MISA failure rate was 10.8% (16/148). The logistic regression analysis showed that a high incidence rate of grade >II RDS before PS administration, low mean arterial pressure and high pulse pressure before administration, a low dose of initial PS administration, and long injection time and operation time were the risk factors for MISA failure (OR=5.983, 1.210, 1.183, 1.055, 1.036, and 1.058 respectively, P<0.05). After the control for the above risk factors, the logistic regression analysis showed that the MISA failure group had a significantly higher incidence rate of bronchopulmonary dysplasia (BPD) (OR=8.537, P<0.05). A high grade of RDS, a low mean arterial pressure, and a high pulse pressure before administration are independent risk factors for MISA failure, and a low dose of initial PS administration, a long injection time, and a long operation time may increase the risk of MISA failure. MISA failure may increase the incidence rate of BPD in preterm infants.

Adverse outcomes of childbirth in high-risk maternity hospitals

Abstract Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death&gt; 2500g and&gt; 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with &gt;2500g and &gt; 37 weeks for more than one day, Apgar &lt;7 at the fifth minute, maternal hemotransfusion and fourth-degree perineal laceration. The data were analyzed using the Statistical Package for Social Sciences software version 22.0. Results: the results showed a 21% rate of adverse outcomes, at a rate of 26.4 for every 1,000 births, with a greater occurrence of neonatal intensive care admission with&gt;2500g and&gt;37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators.

Comparison of the effects of caffeine citrate administering at different time on outcome and neuro-development of premature infants

Objective To investigate the effect of caffeine citrate administering at different time on outcome and neurodevelopment of premature infants. Methods A total of 113 preterm infants with gestational age less than 32 weeks and birth weight less than 1 500 g who were hospitalized and treated in the neonatal intensive care unit from January 2018 to June 2018 were enrolled.According to the time when caffeine citrate treatment was started, they were divided into early treatment group(≤1 days) with 53 infants and late treatment group(1 to 10 days) with 60 infants.A retrospective analysis was performed for their clinical data.The perinatal conditions, treatment process and clinical outcomes of the two groups were compared and the neurological development was followed up at 12 months old. Results Compared with the late treatment group, the early treatment group had a significantly shorter durations of mechanical ventilation time, oxygen therapy time, hospitalization days and a significantly lower incidence of bronchopulmonary dysplasia, patent ductus arteriosusand intraventricular hemorrhage or periventricular leukomalacia, and there were significant differences between two groups(P<0.05, respectively). The neonatal behavioral neurological assessment score in the early treatment group was higher than that in the late treatment group at 40 weeks of gestational age, and there was significant difference between two groups(P<0.05). The mental developmental index at 3 months of corrected age, the mental developmental index and psychomotor developmental index at 12 months were significantly better in the early treatment group than those in the late treatment group, and there were significant differences between two groups(P<0.05, respectively). Conclusion Early use of caffeine citrate can improve the outcome of premature infants and improve the prognosis of nervous system. Key words: Caffeine citrate; Premature infant; Very low birth weight infant; Neural development

Effects of neonatal intensive care unit environmental factors on the physiological functions of low birth weight premature infants

Objective To explore the influence of neonatal intensive care unit (NICU) environmental factors on physiological function of premature infants, and propose improvement plan. Methods A total of 40 cases of low body mass premature infants from June to December in 2017 in Chongqing Center for Women and Children were selected as the research objects, and 8:00-9:00 of working day was set as the daily period, 10:00-11:00 as the quiet period. Light, sound, touch and other environmental factors in NICU were detected quantitatively, basic vital signs, activity, stress hormones and other changes were recorded, and the impact of environmental factors on the children was analyzed. Results Touch times in daily and quiet periods were (5.02±0.54) times/h and (4.56±0.55) times/h, with no significant difference (P>0.05). The same time as the next two days, the activity of premature infants in quiet period was (8.26±3.10), which was lower than that in daily period (17.52±5.78), and the difference was statistically significant (t value was 8.967, P<0.01). The sleep time of premature infants during quiet period (23.24±8.38) was significantly higher than that of daily period (4.80 ±5.39), the difference was statistically significant (t value was-11.679, P<0.01). The levels of cortisol, epinephrine and norepinephrine in premature infants were (61.53±13.47), (15.91±3.94), (49.22±15.15) μg/L in quiet period, which were significantly lower than those in daily period (74.52±20.98), (23.40±11.66), (80.32±32.43) μg/L (t value was 3.295, 3.848, 5.502, P<0.01). The heart rate and systolic pressure of premature infants in quiet period (130.44±8.06) beats/min, (64.05±10.40) mmHg (1 mmHg=0.133 kPa) were significantly lower than those in daily period (145.21±10.52) beats/min, (72.85±13.36) mmHg, and the difference was statistically significant (t value was 3.340, 2.166, P<0.01 or 0.05). Different time periods on the same day, the activity of premature infants in quiet period was (9.87±3.31), which was lower than that in daily period (19.82±5.57), and the difference was statistically significant (t value was 9.761, P<0.01). The sleep time of premature infants during quiet period (25.75±9.07) was significantly higher than that of daily period (4.70±3.89), the difference was statistically significant (t value was-13.457, P<0.01). The levels of cortisol, epinephrine and norepinephrine in premature infants were (59.42±11.95), (15.78±1.45), (50.90±14.73) μg/L in quiet period, which were significantly lower than those in daily period (71.50±20.56), (25.62±11.95), (79.87±29.91) μg/L (t value was 3.212, 5.169, 3.585, P<0.01). The heart rate and systolic pressure of premature infants in quiet period (136.02±11.22) beats/min, (65.35±9.56) mmHg were significantly lower than those in daily period (144.10±9.18) beats/min, (73.47±12.92) mmHg, and the difference was statistically significant (t value was 3.533, 2.008, P<0.01 or 0.05). Conclusions Children with NICU are generally in high noise and strong light environment, these factors will cause adverse physiological reactions to a certain extent. Key words: Neonatal, premature; Intensive care units; Stress sex hormone

Effects of kangaroo mother care on anxiety and parenting stress in premature mothers

Objective To investigate the application effect of kangaroo mother care on anxiety and parenting stress in premature mothers during hospitalization. Methods From January to December 2018, 230 premature mothers were admitted to the neonatal intensive care unit of Ningxia Medical University General Hospital.They were randomly divided into the intervention group(n=114) and the control group(n=116). The premature infants in control group only implemented routine developmental support care.The premature infants in the intervention group was on the basis of routine developmental support care, 2 hours per day of kangaroo mother care was performed from the 2nd day incharge to discharge.Parental Stress Scale: Neonatal Intensive Care Unit and Parenting Stress Index-Short Form was performed using the 2nd day and the 14th day of hospitalization, and the two groups of premature mothers were evaluated for anxiety and parenting stress. Results There were no significant differences in the scores of PSS: NICU((3.65±0.91) vs (3.63±0.91)) and PSI-SF((90.32±8.95) vs (90.12±7.17))(both P>0.05) between the two groups on the 2nd day of hospitalization (before intervention). On the 14th day of hospitalization (after intervention), the total scores ((2.57±0.80) vs (3.47±0.93))and each dimension scores of PSS: NICU in the intervention group were lower than those in the control group (first part (2.41±0.78) vs (3.81±0.73), second part (2.61±0.71) vs (3.14±0.83), third part (2.75±0.86) vs (3.57±1.06), fourth part(2.49±0.80) vs (3.35±0.94))(P<0.01). In addition, the total score of PSI-SF((79.09±8.02) vs (89.46±8.74)), parenting Distress((32.32±9.48) vs (37.15±9.67)), Parent-Child Dysfunctional Interaction((24.26±5.07) vs (27.34±5.26)), and Difficult Child scores((22.51±4.88) vs (24.97±5.05)) in the intervention group were lower than those in the control group(P<0.01). Conclusion Kangaroo mother care can reduce the anxiety of premature mothers during hospitalization and help relieve the parenting stress of premature mothers. Key words: Kangaroo mother care; Premature infant; Anxiety; Parenting stress

Influencing factors associated with transition time to achieve full oral feeding for premature infants in neonatal intensive care unit

Objective To investigate and analyze the influencing factors associated with transition time to achieve full oral feeding for premature infants in neonatal intensive care unit (NICU). Methods A total of 251 NICU hospitalization preterm infants and their mothers meeting the inclusion criteria in Shanghai First Maternal and Infant Health Care Hospital were collected. Finding the medical records to obtain the basic information of the premature infants and feeding conditions, the Self-rating Anxiety Scale (SAS) and the Beck Depression Scale-Ⅱ(BDI- Ⅱ) was used to assess the mothers′ anxiety and depression. Results The transition time to achieve full oral feeding of NICU preterm infants was (5.31±2.93) days. Greater gestational age (β=-0.484, P<0.01), time of breast milk feeding through mouth (β=0.042, P=0.003) had a positive effect on the transition time to achieve full oral feeding. Congenital heart disease (β=0.587, P=0.050), maternal anxiety (β=0.206, P<0.01), depression (β=0.727, P<0.01) and interaction between maternal anxiety and depression (β=0.014, P<0.01) were risk factors of longer time to achieving full oral feeding. The multiple linear regression accounting for a total of 58.2% of all the variation. Conclusions Oral feeding progression in premature infants was influenced by many factors. Gestational age can be the indicators of implementing oral feeding. It is beneficial to initiate oral feeding and feed with breast milk early. If the infants have heart diseases, oral feeding progression would be retardant. Maternal anxiety and depression may prolong the transition time to achieve full oral feeding. Control the factors which affect oral feeding progression, pay attention on mothers′ emotion and formulate appropriate feeding intervention for premature infants to promote full oral feeding are of great importance. Key words: Infant, premature; Neonatal intensive care unit; Oral feeding; Mother; Anxiety; Depression

Prolonged neonatal intubation: Prosthodontics beyond dentistry

Neonates with respiratory distress, inadequate gag reflex, poor sucking, and swallowing commonly require intubation as a routine treatment modality in the neonatal intensive care unit. It can be done by the nasal or oral route. Although nasotracheal intubation reduces the movement of the tube, it has some serious repercussions such as airway obstruction and possible hypoxia, leading to labored breathing, occlusion of the nasal aperture during a crucial period of development, nasal infections, and hypertrophy of the nasal lining. Hence, oral route is preferred over the nasal route as the oral mucosa is less susceptible to infection. However, an infant with an orotracheal tube is at risk for complications such as accidental extubation, damage to the maxillary alveolar ridge, development of a cleft palate, defective dentition, tracheal mucosal damage, subglottic stenosis, and laryngeal damage. Therefore, in an effort to reduce these complications, an appropriate recognition and dental intervention is required by the prosthodontist who by conferring with the prescribing physician could device a customized intraoral appliance for the neonate on prolonged intubation. Various intraoral appliances are being used to stabilize the tubes for infants who require prolonged intubation. For the present review, the database from various digital platforms was searched for studies published on prolonged neonatal intubation. The palatal appliances effectively stabilize the orotracheal and orogastric intubation tubes and prevent the associated complications. Thus, this early prosthodontic treatment for neonates requiring prolonged intubation further expands the scope of prosthetic dentistry to newer horizons in patient care and management.

Umblikal Kateter İlişkili Portal Ven Trombozu: Bir Merkez Deneyimi

Amaç: Yenidoğan yoğun bakım ünitelerinde giderek artan sıklıkta invaziv girişimler yapılmaktadır. Özellikle preterm bebeklere sıklıkla umblikal kateterler takılmaktadır. Bu çalışmanın amacı kliniğimizde takılan umblikalkateterlerin portal ventrombozu (PVT) ile ilişkisini ve risk faktörlerini belirleyebilmektir.Materyal ve metod: Retrospektif olarak 01 Ekim 2017-31 Aralık 2018 tarihleri arasında kliniğimiz yenidoğan yoğun bakım ünitesinde izlenen gestasyon yaşı 32 hafta ve altında olan, umblikal kateter takılan ve en az 6 saat boyunca kateter takılı olan preterm bebekler çalışmaya dahil edildi. Umblikal ven kateteri (UVK) takılan hastaların taburculuk öncesi PVT açısından yapılan portal venöz doppler ultrasonografi (USG) sonuçları ile perinatal risk faktörleri ve kateter ile ilgili özellikler değerlendirildi.Bulgular: 142 hastaya UVK takıldı. 118 hastanın doppler USG sonucuna ulaşıldı. On beş (%9,9) hastada doppler USG ile PVT saptandı. PVT saptanan hastaların hiçbirinde klinik bulgu yoktu. PVT saptanan hastaların ortalama gestasyon yaşı ve doğum ağırlığı, PVT saptanmayan hastalardan daha düşüktü. On dört hastada portal venin sol dalında tromboz saptanırken, bir hastada ana portal vende tromboz saptandı.Tromboz saptanan bir hastada annede gestasyonel diyabet mevcuttu. PVT saptanan hastaların geç neonatal sepsis ve bronkopulmoner displazi oranları daha yüksekti, hastanede yatış süresi daha uzundu. Yine bu grupta kateterin alçak yerleşim oranı daha fazla, kateter kalış süresi ise diğer gruba göre daha uzundu. Sonuç: Umblikal ven kateterizasyonu PVT gelişimi için önemli bir risk faktörüdür. UVK takılan, özellikle düşük doğum ağırlıklı hastalar PVT açısından portal doppler USG ile değerlendirilmelidir.

The current situation of risk assessment and scale applicating of neonatal pressure injury

Objective To investigate the current situation of risk assessment of neonatal pressure injury (PI) and using of the assessment scale from 8 hospitals in Zhejiang Province,providing reference for further improvement of the scale. Methods A cross-sectional study was used to investigate 184 nurses in the department of neonatal intensive care unit admitted to 8 hospitals in Zhejiang Province by using a self-made questionnaire. Results Three of the eight hospitals did not use scale for neonatal PI assessment routinely. Of the remaining five hospitals, three hospitals used Neonatal Skin Risk Assessment Scale (NSRAS), one hospital used Braden Q Pediatric Skin Risk Assessment Scale (Pediatric Braden Q Scale) and one hospital used Neonatal/Infant Braden Q scale (Neonatal/Infant Braden Q Scale). 129 nurses from 5 hospitals evaluated the scales routinely used by the department.Nearly 93.80% (121/129) of the nurses thought the scales were easy to understand, 76.74% (99/129) of the nurses thought the scales were easy to measure, 76.74% (99/129) of the nurses thought the scales were good at predicting, 75.19% (97/129) of the nurses thought the scales were suitable for newborns, 37.21% (48/129) of the nurses thought the scales did not adequately assess the severity of the condition, 34.11% (44/129) of the nurses thought the scales did not adequately assess the medical device factors, 24.81% (32/129) of the nurses thought the scales scores were not clearly defined. Conclusion The use of risk assessment scale for neonatal PI has not been unified yet, and the three scales need to be improved. The department should pay attention to the risk assessment of newborn PI and strengthen the awareness of PI prevention. Key words: Pressure injury; Intensive care unit, neonatal; Tool; Cross-sectional studies

Investigation on epidemiology of nosocomial sepsis of premature infants with gestational age less than 34 weeks in Shaanxi province: a multicenter study

Objective To investigate the epidemiological data of nosocomial sepsis of premature infants with gestational age less than 34 weeks and the distribution characteristics of pathogenic bacteria in Shaanxi province. Methods A retrospective analysis of clinical data of premature infants born with gestational age < 34 weeks born between January 1 and December 30, 2018 in Neonatal Intensive Care Units(NICU) in 4 Grade A Class Three hospitals in Shaanxi province was performed.The high risk factors and pathogenic bacteria were analyzed by using chi-square test and t test for statistical analysis. Results Totally 823 infants were included in this study, among whom, 73 patients developed nosocomial sepsis, and the incidence was 8.9%.The mean gestational age of the 73 patients with nosocomial sepsis was (30.6±2.2) weeks and mean birth weight was (1 320.3±450.5) g. The rate of invasive ventilator was 23.4%(52/222 cases). The rate of peripherally inserted central catheter (PICC) was 20.1% (61/303 cases). The rate of early antibiotic use was 8.1% (39/481 cases) and breast feeding rate was 9.3% (63/675 cases). The rate of PICC and ventilator use were statistically different between the non-infection group and the infection group(all P<0.05). There were 31 strains of pathogenic bacteria, among which gram-negative bacilli was the most common (22 strains, 70.9%), which mainly were klebsiella pneumoniae strains (15 strains, 48.4%), and 6 strains(19.4%) of Fungus was detected. Conclusions The incidence of nosocomial sepsis in NICU in Shaanxi province is higher, gram-negative bacilli was the most common pathogenic bacteria, among which, klebsiella pneumoniae was main, it is necessary to strengthen the regular monitoring and analysis of nosocomial infection in NICU in order to reduce the incidence of nosocomial infection and sepsis. Key words: Infant, premature; Sepsis; Multi-center study; Pathogen

Common problems and counterplans of extracorporeal membrane oxygenation implementation in neonatal intensive care unit

Extracorporeal membrane oxygenation (ECMO) is by far one of the most advanced life support technology, which provides temporary cardiopulmonary support and earns precious time for patients waiting for the recovery of organ function.However, due to various factors and constraints, this technology is still at the initial stage of application in neonatal field in China.In the meantime, there are many problems to deal with.This article will mainly discuss about several aspects in ECMO management, including choice of patients, timing to start, choice of ECMO mode, management of running ECMO, complications and ethic issues. Key words: Extracorporeal membrane oxygenation; Infant, newborn; Treatment; Complication

Nurses' underuse of non-pharmacological pain relief interventions in preterm infants.

The aim of this literature review was to explore nurses' underuse of non-pharmacological pain relief interventions for minor procedures in preterm infants on neonatal intensive care units (NICUs). A search of the literature using keywords was undertaken using multiple databases. After inclusion and exclusion criteria were applied, three main themes emerged from 11 studies: preterm infant factors; nurse factors; and organisational factors. The literature review found that nurses consistently underused non-pharmacological pain relief interventions for minor procedures in preterm infants. Several contributory factors were identified, including the absence of pain guidelines, the quality of nurses' training and education, patient acuity, the lower gestational age of patients, and the intensity level of NICUs. Recommendations for future practice include the implementation of pain guidelines and validated pain assessment tools via neonatal clinical networks and local pain champions. Effective dissemination of education and training for nurses in pain affecting preterm infants is also required to overcome barriers such as staff shortages and excessive workloads.

Pattern of Blood Stream Infections and their antibiotic susceptibility profile in a Neonatal intensive care unit of a tertiary care hospital; a current perspective.

To determine the pattern of blood stream infections and their antibiotic susceptibility profile with infectivity predictors in a neonatal setting. The descriptive cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from December 1, 2016,to April 30, 2018, and comprised blood culture samples received in Bactec/BactAlert paediatric bottles from neonates aged 0-30 days admitted in the neonatal intensive care unit. The samples were processed as per the standard guidelines. Antibiotic susceptibility was checked as per guidelines of the Clinical and Laboratory Institute. VITEK 2 system was used for rapid identification and minimum inhibitory concentrations of the drugs. SPSS 24 was used for data analysis. Out of 640 samples, 172(27%) were culture-positive. Among them, 98(57%) were gramnegative rods, 50(29%) gram-positive cocci and 24(14%) were fungi. Of the 172 pathogens identified, Klebsiella pneumoniae was 39(22.7%) followed by Candida species 24(14%) and methicillin-resistant Coagulase-negative staphylococci 20(11.6%). Of Klebsiella pneumoniae isolates, 26(58%) were extended spectrum -lactamase producers. Among Acinetobacterbaumanii, 11(58%) were extensively drug resistant and Carbapenem-resistant strains were 20(91%). Also, 4(8%) isolates of Enterococcus faecium were vancomycin-resistant. Majority of the isolates causing blood stream infections in neonatal intensive care unit were multi drug resistant, posing a therapeutic challenge for the neo natologists .

Does the over-medicalisation of pregnancy help to improve neonatal outcomes?

Abstract Introduction The over-medicalization of pregnancy is frequent, especially in high-income countries and comports unnecessary costs for health systems. In Italy the national health service guarantees access to health care services, but still a lot of pregnant women search for private health care. This study aimed to analyse if the over-medicalization of pregnancy had an impact on neonatal outcomes. Methods The cross-sectional study was conducted in Siena (Italy), data were extracted from medical records. All women that gave birth between January 2016-May 2018 and were classified as “low/moderate risk” pregnancy were included. Examined variables were: age, number of obstetrics and ultrasound (US) visits (≤9/≥10), timing of the first visit (&amp;lt;12weeks/&amp;gt;12weeks of pregnancy), health facility (public/private), previous spontaneous abortions (SA) or voluntary interruptions of pregnancy (VIP). The outcome variables were preterm birth (PB) and admission in neonatal intensive therapy unit (NITU). Analysis was performed with Stata 12. Results A total of 2392 women were included; 22% with≥10 obstetrics visits; 19% with≥10 US visits; 87% had the first visit before 12 weeks of pregnancy and 57% were followed by a private healthcare facility. Six percent of babies were born preterm and 11% were admitted in NITU. The PB condition appeared associated with SA (OR:2.4, 95%CI 1.6-3.6 p &amp;lt; 0.001) and VIP (OR:1.8, 95%CI 1.2-2.8 p &amp;lt; 0.005). Admission in NITU was associated with previous VIP (OR:1.4, 95%CI 1.01-2.03 p &amp;lt; 0.05) and PB (OR:2.16 95%CI 1.37-3.41 p = 0.001). Multiple logistic regression identified only PB as associated with this outcome. Conclusions Neonatal outcomes do not show association with number of obstetric/US visits and the type of health facility. It seems that controlled pregnancy does not help to reduce the risk of adverse events as premature birth or admission in intensive therapy. Key messages The over-medicalization of pregnancy is frequent, especially in high-income countries and it has an important impact on health-related costs. More controlled pregnancy does not help to reduce the risk of adverse events as preterm birth and necessity of recovery in neonatal intensive therapy unit.

Breastfeeding and Birth mode: comparative analysis between elective and in-labor caesarean section

Abstract Introduction Evidence in literature suggests that the outcomes of children born by in-labor non-emergency caesarean section (CS) are better if compared to those born by programmed CS. The aim of this work was to evaluate impact of type of CS on neonatal outcomes and breastfeeding. Materials and methods The cross-sectional study was performed in the Siena province (hospital of Siena and Poggibonsi) during the period January-December 2015. All females that gave birth by CS were included, except those that had emergency CS from severe medical indication (pre-eclampsia/eclampsia, fetal distress, intrauterine growth retardation, etc) or due to multiple pregnancy. The sample was divided in two groups (programmed CS/CS in the presence of labor). The outcome variables were: necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation; weight loss after birth (%), hours passed between birth and first attack to the breast, type of breastfeeding at discharge (exclusive/mixed). The statistical analysis was performed with Stata 12. Results In total 446 females were included (53.6% programmed CS). Any association between the type of CS and admission to NITU or resuscitation was observed. Among the newborns born by CS in the presence of labor, there was a greater proportion of babies who attached to the breast immediately after birth (82% vs. 71%; p &amp;lt; 0.05) and also those exclusively breastfed at the moment of discharge (71% vs. 60%; p &amp;lt; 0.05). The weight loss was lower in babies born by CS in the presence of labor (8%±1.8; 95% CI 7.7%-8.2% vs. 8.53%±1.7%; 95% CI: 8.3%-8.8%; p &amp;lt; 0.05). Conclusions Our study confirmed the negative impact of the CS in the absence of labor on the breastfeeding initiation, probably due to incomplete activation of neuroendocrine mechanisms (release of oxytocin; etc). The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding. Key messages In-labor non-emergency caesarean section is more physiological and helps to initiate and maintain breastfeeding. The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding.

Effect of comprehensive feeding intervention on feeding intolerance of premature infants

Objective To investigate the effect of comprehensive feeding intervention on feeding quality and weight gain of premature infants. Methods Eighty-one premature infants admitted to the neonatal intensive care unit (NICU) of our hospital from September 2016 to December 2018 were selected and randomly divided into the intervention group (n=41) and the control group (n=40). Infants in the control group received routine nursing and infants in the intervention group were given comprehensive feeding intervention on the basis of routine nursing includingimproved Y type gastric tube, gravity tube feeding in prone position, oral movement intervention, colostrum oral immunotherapy and kangaroo nursing. The changes of feeding process were compared between the two groups and the occurrence of feeding intolerance in the two groups was observed. Results The duration of tube feeding and hospital stay were lower in the intervention group than in the control group (P 0.05), but the average daily weight growth rate [g/(kg·d) ] after 1 week and the milk volume [ml/(kg·d)] at 1 week were higher in the intervention group than in the control group(P<0.05). The incidence of gastric retention, abdominal distension and vomiting in the intervention group was lower than that in the control group, but only the difference in the incidence of gastric retention (24.4% vs 47.5%) was statistically significant (P<0.05). The incidence of feeding intolerance was significantly lower in the intervention group than in the control group (24.39% vs 47.50%, P<0.05). Conclusion Comprehensive nursing intervention can shorten the tube feeding time of premature infants, promote the weight growth of premature infants, improve the feeding quality, reduce the incidence of feeding intolerance, and reduce the hospital stay of premature infants, so as to reduce the hospitalization cost, improve the quality of life of premature infants, and increase the satisfaction of parents. Key words: Comprehensive nursing intervention; Premature infant; Feeding intolerance